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Bipolar Disorder and Addiction: Everything You Need to Know

By Will Solomon, Taylor Weeks
Medically Reviewed by Yilang Tang, MD, PhD on July 11, 2021
Bipolar disorder and substance use disorder are separate conditions, but there is a strong association between them.

Bipolar disorder is a mental health condition that presents with severe mood swings. These mood swings alternate between periods of extreme emotional highs (called mania) and periods of depression. Like many types of mental illness, bipolar disorder is a risk factor for addiction, including substance use disorders. 

Is There a Link Between Bipolar Disorder and Addiction?

Bipolar disorder and addiction have a high level of comorbidity — meaning that people often experience both at the same time. According to the Substance Abuse and Mental Health Services Administration (SAMSHA), research suggests that as many as 30-50% of people with bipolar disorder may develop comorbid substance abuse disorder at some point in their life. Similarly, Mayo Clinic lists drug and alcohol abuse as a risk factor for developing bipolar disorder.

While we know that people with bipolar disorder are more likely than the general population to develop substance use disorder, it's hard to say why exactly this is the case.

However, in their 2020 research report on common comorbidities with substance use disorder, the National Institute on Drug Abuse (NIDA) explains that there are three main pathways that contribute to the association between substance use disorder and mental illnesses, including bipolar disorder.

1. Shared risk factors may contribute to both bipolar disorder and addiction.

Bipolar disorder and drug addiction are both health issues that can be caused by a complex mix of factors. It's possible that the same factors are contributing to both conditions in people who experience them at the same time. For example, the National Institute on Drug Abuse explains that certain genetic differences may contribute to both bipolar disorder and addiction.

Environmental and lifestyle factors can also play a significant role. “Bipolar disorder and substance abuse are linked due to a reciprocal effect,” Paul DePompo, PsyD and clinical psychologist at Cognitive Behavioral Therapy Institute of Southern California tells WebMD Connect to Care. “When one is on the depressed side of bipolar, they can crave the dopamine rush of alcohol and other substances. In addition it can trigger a hypomanic or manic episode when done [in] excess.”

This interplay of bipolar symptoms and substance misuse can create a cycle that ultimately worsens both conditions. “Individuals with bipolar disorder often crave that hypomanic feeling that takes them out of depression and does not have the potential danger associated with a manic episode,” says DePompo. “Still, the use of substances to achieve this not only does not work–but feeds into the manic-depressed cycle.

2. Symptoms of bipolar disorder may contribute to drug use and addiction.

Nadia Bening, MD, a psychiatrist at Driftwood Recovery Center in Austin, Texas, tells WebMD Connect to Care that a large number of people with bipolar disorder may try to self-medicate with drugs or alcohol to deal with their symptoms. According to Bening, people may use particular drugs during manic or depressive episodes for specific reasons. 

During a manic episode, someone may use amphetamines or cocaine to prolong the period of high energy and excitement, or they may use downers like alcohol or sedatives to try to calm down. While experiencing a depressive episode, they may use stimulants in an attempt to elevate their mood or energy level, or sedatives to distract from feelings of sadness or hopelessness.

So can bipolar cause addiction? Not exactly—but because of the frequent comorbidity of the two conditions, it can certainly make some individuals much more prone to developing a substance use disorder.

3. Drug use and addiction may contribute to the development of bipolar disorder. 

“Although people with bipolar disorder may turn to drugs or alcohol out of a need to stabilize their moods,” Bening says, “engaging in substance abuse has the opposite effect, making the symptoms of bipolar disorder worse.” Substance abuse can make manic or depressive episodes last longer, or make their symptoms more severe. Bening explains that substance abuse can also lead to changes in the brain that may contribute to the development of bipolar disorder.

What Drugs Can Trigger Bipolar Disorder?

According to the South African Federation for Mental Health, there are a number of types of drugs that can trigger bipolar disorder. These include alcohol, phencyclidine (PCP0, hallucinogenic drugs, and amphetamines. However, this does not mean that use of these drugs will reliably lead to bipolar disorder in all (or most) individuals—nor does it mean that these are the only types of drugs that can potentially induce bipolar disorder.

Rather, a number of circumstances and factors intersect around drug use to trigger bipolar disorder. “If your body has the genetic links to bipolar disorder and you are stressing your body with substances, that could be enough to push someone over to have their bipolar come to the surface,” DePompo says. “Chronic substance use of any kind can be a contributing factor.”

Does Drug-Induced Bipolar Go Away?

According to the National Library of Medicine, substance-induced bipolar disorder typically resolves once the substance in question is withdrawn. However, in certain individuals, a major and even life-threatening depressive or bipolar episode can develop, which can have lasting repercussions.

This said, the diagnosis of bipolar disorder can be complex, and the disorder can result from a confluence of factors, including genetic and environmental elements. Accordingly, some experts express a need for caution around the diagnosis of drug-induced bipolar. “Drug-induced bipolar is often a different diagnosis and [a] professional can make the error of diagnosing bipolar too early when chronic substance use was at the helm of the manic episode,” DePompo says. In other words, an episode may look like bipolar disorder, though that may not really be an appropriate diagnosis.

“A substance-induced psychosis can look like bipolar. One should get an accurate diagnosis once they are stabilized and free of substances for an accurate diagnosis,” DePompo says.

Do Drugs Make Bipolar Worse?

 

While the interaction between bipolar disorder and substance abuse is complex, one thing is abundantly clear: drugs do make bipolar disorder worse. A 2019 study in the journal Current Medical Research and Opinion noted that substance use makes treating bipolar depression more difficult because it:

  • Increases bipolar morbidity and mortality, and 
  • Raises suicide risk. 

The study even notes “that approximately 60% of patients with bipolar I disorder have a lifetime diagnosis of substance use disorder.”

“Drugs absolutely worsen bipolar disorder,” DePompo says. “Substances in bipolar disorder are like a high interest credit card. It may seem helpful in the moment, yet eventually the bill will come with interest.”

Is Substance Abuse Common with Bipolar Disorder?

As noted above, substance abuse is extremely common with bipolar disorder, and up to half of people diagnosed with bipolar disorder may develop substance abuse disorder at some concurrent time. A 2007 study in the journal Substance Abuse Treatment, Prevention, and Policy found that those with bipolar I disorder had at least a 40% lifetime prevalence of substance use disorders, and those with bipolar II had at least 20% lifetime prevalence. The study also noted that alcohol and cannabis were the most common drugs being misused.

A 2017 meta-analysis in the journal Psychiatry Research added some additional detail to those findings, noting that males with bipolar disorder, as well as those with a pattern of more manic episodes and a history of suicidality, were more prone to substance use disorders.

Does Bipolar Lead to Alcoholism?

 

Alcohol abuse, like other substance use disorders, is quite common with bipolar disorder. “There is a strong link between bipolar disorder and alcohol use,” DePompo says. “The impulsivity of mania often leads to risky behavior like alcohol use. The anxiety and depression that comes with bipolar can get temporarily satiated by alcohol only to lead to more anxiety and depression as your body recovers, i.e. ‘hangxiety.’”

According to  Mayo Clinic, there is a strong link between bipolar disorder and alcohol use disorder. In addition to mania (which may lower inhibitions or impair judgment, and thus lead to increased alcohol use), other features of bipolar disorder can be linked to alcohol abuse. These features include:

  • Attempts  to ease the depression and anxiety often associated with bipolar disorder
  • Genetic traits that can make an individual more prone to developing both bipolar disorder and a substance use disorder (including alcoholism)

Sometimes, the use of alcohol, combined with behavioral patterns of mania and depression, combine to produce a cycle that worsens both disorders.

However, bipolar disorder does not “lead” to alcoholism in a strict sense. It may heighten the risk, particularly in individuals with existing risk factors, but a large portion of individuals with bipolar disorder do not have comorbid alcohol use disorder.

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